Dennis, C. L., & Ross, L. (2005).Birth, 32(3), 187-193.
This longitudinal study adds to the growing body of research on factors associated with postpartum depression. These investigators examined the relationships among maternal fatigue, infant sleep patterns, and the development of depressive symptomatology in women living near Vancouver, British Columbia. Women who did not have major depressive symptomatology at 1 week postpartum, based on having an Edinburgh Postnatal Depression Scale (EPDS) score of less than 13 (Cox, Holden, & Sagovsky, 1987), were mailed questionnaires at 4 and 8 weeks. Of the 505 eligible women, 456 (90.3%) returned the 4-week postpartum questionnaire, while 425 (84.2%) returned the 8-week questionnaire. Approximately 5% of the women reported depressive symptoms (defined as an EPDS score of >12) at 4 and 8 weeks postpartum. The following variables were associated with depressive symptoms at both 4 and 8 weeks postpartum: self-reported fatigue, getting less than 6 hours of sleep in a 24-hour period, and frequent infant crying.
A strength of this study is that the investigators avoided confounding the sleep-related symptoms of depression with infant-related disruptions in sleep by limiting the analysis to women without significant depressive symptoms at 1 week postpartum. Caution should be used in generalizing the results, since the majority of participants were white (93%), were married (92%), and had at least a high school education (96%). In addition, the study was not designed to demonstrate cause-and-effect relationships. Nonetheless, the results suggest that maternal fatigue, sleep deprivation, and infant sleep patterns are strongly associated with new onset of depressive symptoms in the postpartum period. Nurses need to be alert for postpartum women who get less than 6 hours of sleep per day, and whose infants have frequent awake episodes at night and cry frequently. These women should be carefully screened for postpartum depression, and strategies to facilitate obtaining more sleep should be discussed with the woman and her family. Future research is needed to study the effect of social support and infant feeding method on maternal sleep patterns, since these factors were not examined in this study.
Comment by Maureen Heaman
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